The treatment of the aging neck is still a challenge to the plastic surgeon.The results of anatomic studies of the platysma muscle and its role in the treatment of the aging neck are presented.Dissection of 50 cadavers revealed differences in the distribution of the medial fibers of the platysma muscle in the suprahyoid region that could significantly affect surgical results. A 4-cm incision at the submental area, 0.3 to 0.4 mm behind the submental crease, and submental skin undermining permitted visualization of the medial fibers of the platysma. The medial fibers were dissected laterally and excess muscle removed. The fibers were sutured without tension to the median line, followed by a medial section at the level of the cricoid cartilage.With the use of the approach described here, very good results were obtained in the treatment of patients who presented with deformities in the median line of the neck.Appropriate treatment of the platysma, based on anatomic analysis and facilitated by the submental approach, is the key to optimal results in the treatment of the aging neck. (Aesthetic Surg J 2003;23:165-169.).